Consultations Preliminary to Interdisciplinary Chronic Pain Rehabilitation

Patients’ and Practitioners’ Orientations to the Institutional Significance of a Shared Understanding of the Pain

Abstract

Before patients with chronic pain enter an interdisciplinary chronic pain rehabilitation programme, a team of various healthcare professionals performs a biopsychosocial analysis of their pain problem. To enhance patients’ engagement, the problem analysis is thoroughly discussed with them in order to gain a shared understanding of the nature of their pain problem. This study explores how patients and practitioners talk through their rehabilitation team’s hypotheses regarding the psychosocial factors involved in these patients’ health situation. Nine consultations were recorded at various Dutch interdisciplinary chronic pain rehabilitation units. The recordings were transcribed and analysed, combining an applied conversation analytic research approach with discursive psychology. Patients and practitioners are found to orient to ensuring consensus on the problem analysis as a relevant activity and tend to avoid or minimize the articulation of differences in perspectives. This study also shows that this orientation to consensus involves a delicate management of issues of accountability and blame. Findings can be used by practitioners to consider communication practices that are more likely to encourage patients to voice potential concerns regarding their rehabilitation team’s findings.